I-STOP law poses opportunities, concerns about implementation

The tragedies caused by prescription drug abuse, addictions, overdoses and ruined lives are not unique to New York state, but Assemblyman Michael Cusick realized a couple years ago that Staten Island, where his district is located, could be considered the epicenter of the problem.

“We have numbers that are staggering of people overdosing from prescription drugs and the theft of prescription drugs," Cusick said. "The misuse is rampant here on Staten Island."

But he also realizes that there is no magic legislation that’s going to solve the whole problem. Cusick chose to look at what he could do on a state level.

The problem of so-called ‘doctor shopping’ was a problem Cusick thought the legislation could address. Doctor shopping is the practice of going from doctor to doctor to obtain a prescription, usually unnecessary to the patient. It’s a practice driven by addiction.

The I-STOP law creates on online database that doctors must consult before prescribing medications that are prone to abuse. Pharmacists also have access to this database.

Another part of the law makes hydrocodone, or drugs that include it, more restricted since these medications are high on the list of those that are abused. Hydrocodone can no longer be refilled without a visit to the doctor, and in 2014 I-STOP requires that all prescriptions be electronically prescribed. This prevents stolen prescription pads used for illegitimate purposes.

The assemblyman admits that like many new laws, I-STOP may have unintended consequences.

“This will be an inconvenience for those patients who truly need and rely on the pain medication, but we feel that this is a very highly abused drug illegally,” Cusick said.

Doctors who treat cancer patients, especially those who are terminally ill, believe it’s going to be more than just an inconvenience. They say it could cause more patients to suffer through the pain of their disease. Dr. Joseph Navone is president of the Upstate New York Society of Medical Oncology and Hematology, and he says I-STOP is well-intentioned to combat a serious problem. But he predicts that cancer patients may be less likely to share their symptoms with their doctors, because they don’t want to be put on the prescription drug database.

Dr. Navone also worries that this law will make cancer patients more worried that they will become addicted to drugs like hydrocodone. Finally, he says that the law could create less access to care for patients because of the time commitment that accompanies I-STOP.

“We’re already working in a very controlled environment where sometimes I feel that I’m actually spending more time documenting what I’m doing for my patients as opposed to actually sitting down face to face and treating them,” he said.

The Upstate Society of Medical Oncology requested an exemption from the law, which was not immediately granted, but Dr. Navone does think I-STOP is likely to help stop doctor shopping and what he calls ‘diversion;’ a family member taking drugs from a patient who has legitimately been prescribed them.

“I think that by creating this law we may see a decrease in things such as diversion and doctor shopping but I’m worried about what they will do then,” Dr. Navone said. “I think most people that have an intent to obtain something not in a legal manor will still find a way to do it anyway.”

Assemblyman Cusick admits that no law is perfect, but he says all laws can be adjusted. That’s why I-STOP created a working group to deal with the many nuances of the complicated issue of prescription drug abuse.